angina

abdominal angina

Abdominal pain that occurs after meals, caused by insufficient blood flow to the mesenteric arteries. This symptom typically occurs in patients with extensive atherosclerotic vascular disease and is often associated with significant weight loss. Synonym: intestinal angina; bowel ischemia

Patient care

Medical intervention for abdominal angina can include supportive care including anticoagulant therapy. Surgical intervention includes angioplasty, partial colectomy, (removing the ischemic section of the bowel and reconnecting the remaining ends). It may be necessary to create a colostomy or ileostomy and to correct blockages in the mesenteric arteries. The patient must be monitored for signs and symptoms of peritonitis and/or sepsis. As the patient recovers, patient education focuses on prevention of further episodes, recognition of signs and symptoms including cramping abdominal pain after eating, blood in the stool, red or black stools, diarrhea and/or constipation. It also includes instructions and support for living with permanent or temporary colostomy or ileostomy.

angina decubitus

Attacks of angina pectoris occurring while a person is in a recumbent position.

angina of effort

exertional angina

intestinal angina

Ludwig angina

angina pectoris

An oppressive pain or pressure in the chest caused by inadequate blood flow and oxygenation to heart muscle. It is usually due to atherosclerosis of the coronary arteries and in Western cultures is one of the most common emergent complaints bringing adult patients to medical attention. It typically occurs after (or during) events that increase the heart's need for oxygen, e.g., increased physical activity, a large meal, exposure to cold weather, or increased psychological stress. See: illustration; table

Symptoms

Patients typically describe a pain or pressure located behind the sternum and having a tight, burning, squeezing, or binding sensation that may radiate into the neck, jaw, shoulders, or arms and be associated with difficulty in breathing, nausea, vomiting, sweating, anxiety, or fear. The pain is not usually described as sharp or stabbing and is usually not aggravated by deep breathing, coughing, swallowing, or twisting or turning the muscles of the trunk, shoulders, or arms. Women, diabetics, and the elderly may present with atypical symptoms, such as shortness of breath without pain.

Treatment

In health care settings, oxygen, nitroglycerin, and aspirin are provided, and the patient is placed at rest. Morphine sulfate is given for pain that does not resolve after about 15 min of treatment with that regimen. Beta-blocking drugs (such as propranolol or metoprolol) are used to slow the heart rate and decrease blood pressure. They are the mainstay for chronic treatment of coronary insufficiency and are indispensable for treating unstable angina or acute myocardial infarction. At home, patients should rest and use short-acting nitroglycerin. Patients with chronic or recurring angina pectoris may get symptomatic relief from long-acting nitrates or calcium channel blockers. Patients with refractory angina may be treated with combinations of all of these drugs in addition to ranolazine, a sodium channel blocker.

Patient care

The pattern of pain, including OPQRST (onset, provocation, quality, region, radiation, referral, severity, and time), is monitored and documented. Cardiopulmonary status is evaluated for evidence of tachypnea, dyspnea, diaphoresis, pulmonary crackles, bradycardia or tachycardia, altered pulse strength, the appearance of a third or fourth heart sound or mid- to late-systolic murmurs over the apex on auscultation, pallor, hypotension or hypertension, gastrointestinal distress, or nausea and vomiting. The 12-lead electrocardiogram is monitored for ST-segment elevation or depression, T-wave inversion, and cardiac arrhythmias. A health care provider should remain with the patient and provide emotional support throughout the episode. Desired treatment results include reducing myocardial oxygen demand and increasing myocardial oxygen supply. The patient is taught the use of the prescribed form of nitroglycerin for anginal attacks and the importance of seeking medical attention if prescribed dosing does not provide relief. Based on his needs, the patient should be encouraged and assisted to stop smoking, maintain ideal body weight, lower cholesterol by eating a low-fat diet, keep blood glucose under control (if the patient is diabetic), limit salt intake, and exercise (walking, gardening, or swimming regularly for 45 min to an hour every day). The patient is also taught about prescribed beta-adrenergic or calcium channel blockers and any other needed interventions should they become necessary.

Four major forms of angina are identified: 1. stable: predictable frequency and duration of pain that is relieved by nitrates and rest; 2. unstable: pain that is more easily induced and increases in frequency and duration; 3. variant: pain that occurs from unpredictable coronary artery spasm; and 4. microvascular: impairment of vasodilator reserve that causes angina-like chest pain even though the patient’s coronary arteries are normal. Severe and prolonged anginal pain is suggestive of a myocardial infarction.

Class

Description

I

Ordinary physical activity, such as walking or climbing stairs, does not cause angina. Angina occurs with strenuous, rapid, or prolonged exertion at work or recreation.

II

Slight limitation of ordinary activity. Angina occurs on walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold, or in wind, under emotional stress, only during the few hours after awakening, or walking more than two level blocks and climbing more than one flight of stairs at a normal pace and in normal conditions.

III

Marked limitation of ordinary physical activity. Angina occurs on walking one to two level blocks and climbing one flight of stairs in normal conditions at a normal pace.

IV

Inability to carry on any physical activity without discomfort—angina symptoms may be present at rest.

preinfarction angina

Angina pectoris occurring in the days or weeks before a myocardial infarction. The symptoms may be unrecognized by patients without a history of coronary artery disease.

silent angina

Unrecognized angina pectoris that presents with symptoms other than chest pain or pressure. The patient may experience dyspnea on exertion, heartburn, nausea, pain in the arm, jaw pain, tenderness in back or arms (in women), or other atypical symptoms. Silent angina pectoris occurs most often in older adults, in women, in postoperative patients who are heavily medicated, or in patients with diabetic neuropathy.

stable angina

Angina that occurs with exercise and is predictable. It is usually promptly relieved by rest or nitroglycerin.

unstable angina

Abbreviation: UA

Angina that has changed to a more frequent and more severe form. Its symptoms include chest pain that occurs with minimal exertion (or that progresses from pain with exertion to pain occurring with minimal exertion or at rest) and may be an indication of a severe obstruction in a coronary artery and impending myocardial infarction. It is a medical emergency, and should be aggressively managed.

variant angina

Angina due to spasm of the coronary arteries rather than from exertion or other increased demands on the heart. The pain typically occurs at rest. During coronary catheterization the spasm is usually found near an atherosclerotic plaque, often in the right coronary artery. Infusions of ergonovine may provoke it. On the electrocardiogram, the diagnostic hallmark is elevation of the ST segments during episodes of resting pain. Treatments include nitrates and calcium channel blocking drugs. Beta-blocking drugs, frequently used as first-line therapy in typical angina pectoris, are often ineffective with this angina.

Vincent angina

an·gi·nal

(an'ji-năl)

Relating to angina in any sense.

Patient discussion about anginal

Q. I still have chest pain after 5 angioplasties/stents. Does anybody else still have that much angina?

A. my uncle had the same problem. went through several catheterization at several different cardiologist (some are well known), but couldn't get this annoying pain off his chest. the weird part was that it didn't even reacted to effort. but eventually (i don't remember the stent amount) one of the cardiologist solved the problem. so don't give up and continue searching the cause!

38), (39) One dramatic study demonstrated that both arjuna and the drug, isosorbide reduced anginal attacks significantly, but only arjuna-supplemented patients had significant improvement in their hearts' blood pumping abilities.

The recommendations supported by a level of evidence A state that FFR measurements can be useful in assessing whether an intervention in a coronary lesion is necessary, as an alternative to noninvasive functional testing, and to help assess intermediate stenosis in patients with anginal symptoms.

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